Pressure Wounds and Skin Integrity Issues

Skin integrity refers to skin health. A skin integrity issue might mean the skin is damaged, vulnerable to injury or unable to heal normally.

A pressure wound (also called a pressure sore, bed sore or pressure ulcer) is an injury to the skin and surrounding tissue. Pressure wounds usually form over bony prominences (places where the bone is close to the surface of the skin) of the body, such as:

• Hips.
• Sitting bones.
• Shoulder blades.
• Base of the spine.

If not treated early, wounds can become infected or require surgery to repair.

The most common cause of pressure wounds and skin integrity issues is constant pressure to the skin as it gets squeezed against a surface (such as a bed or wheelchair). Continued pressure reduces blood flow to the area, causing injury. Pressure wounds and skin integrity issues usually happen if a child remains in one position for a long time.

Other causes of pressure sores and skin integrity issues include:

• Sliding down a chair or bed.
• Pulling across a chair or bed.
• Irritation from sweat or other bodily fluids.

Children who are at risk of developing bed sores and skin integrity issues often:

• are paralyzed
• can’t feel pain or pressure
• use braces, casts or a wheelchair
• spend a lot of time in one position
• don’t have control of their bowels or bladder
• have trouble thinking clearly
• have difficulty managing their health
• don’t eat a balanced diet or drink enough water
• are overweight

If your child is at risk for pressure wounds and skin integrity issues, you should check for signs of problems every day. Your health care provider can help you evaluate any signs of developing wounds.

Some of the most common pressure sore symptoms and signs of skin integrity issues include:

• a red or pink appearance on lighter skin
• an ashen, blue or purple appearance on darker skin
• pain in the area
• a firmer, softer, warmer or cooler feeling in the area compared to other parts of the body
• an area that doesn’t lose color (blanch) when pressed

Although daily skin checks offer the best chance of preventing problems, children at risk of pressure wounds and skin integrity issues should also:

• drink plenty of water
• eat a balanced diet
• keep their skin clean
• use a barrier cream over the buttocks and groin at every change of brief/diaper to prevent the skin from absorbing excess moistures
• schedule regular visits with orthotists, seating practitioners and durable medical equipment vendors to make sure braces and seating fit properly
• change position every two hours when in bed
• change position for at least two minutes every hour if using a wheelchair
• get out of a wheelchair every few hours
• avoid excessive layers of clothing, sheets or materials
• avoid dragging or pulling skin across surfaces when moving from a wheelchair to a bed (transferring)

If your child has pressure wounds or skin integrity issues, Gillette Children’s offers several services to help prevent, treat and manage their condition. Our integrated care model is centered on treatment for complex conditions, such as those that can lead to problems with skin integrity or bed sores.

Gillette specialists certified in wound care, test skin integrity, help with wound management, and educate your family about pressure wound prevention and skin integrity issues. If you ever notice issues during a routine skin check, or have questions about preventing pressure wounds, contact Gillette and speak to a nurse.

Pressure Mapping